Dementia May Never Improve, but Many Patients Still Can Learn

This approach may represent the future for the growing number of older adults around the world with dementia. Trials of drugs to prevent or treat dementia have failed over and over. Even if some future treatment demonstrated effectiveness, millions of people and their stressed family caregivers need help now.

“We can’t wait another 20 years for some magic pill,” said Laura Gitlin, dean of the College of Nursing and Health Professions at Drexel University. She has developed something called the Tailored Activity Program (T.A.P.), somewhat similar to cognitive rehab, which also brings occupational therapists into people’s homes.

“We’re trying to lay the scientific basis for nonpharmacological approaches,” Dr. Gitlin said. “These studies signal that they can have powerful effects on peoples’ lives.”

In the United Kingdom, for instance, a government-supported trial involving 475 people with early-stage dementia found that after cognitive rehab, most participants attained their goals, while those in a control group did not, and they maintained improvement at three months and at nine months. (The study has not yet been published; Dr. Clare presented the results at a conference last year.)

A smaller trial of cognitive rehab by Belgian researchers, recently published in the Journal of Geriatric Psychiatry and Neurology, found that patients with early Alzheimer’s disease remained better able to do their chosen activities after a year.

“More and more, people will understand how many preserved abilities there are in dementia, and that will help change minds,” said Eric Salmon, director of the memory clinic at the University of Liege in Belgium and the senior author of that study.

In the United States, Dr. Gitlin’s T.A.P. program includes more patients with serious cognitive loss than cognitive rehab does. And it takes a somewhat different tack: T.A.P. aims to reduce the troubling behaviors that can accompany dementia: repeated questions, wandering, rejecting assistance, verbal or physical aggression.